Reference no: EM132107271

Patient Presentation and History A 62-year-old man presented to the emergency department (ED) with severe shortness of breath. His symptoms had begun 4 days previously when he ran out of his "water pills." He also complained of dyspnea on exertion, difficulty breathing when lying supine, and swelling of his feet. His past medical history was significant for hypertension and congestive heart failure (CHF). His normal medications included furosemide 40 mg b.i.d. and a clonidine 0.4 mg patch. He reported having no money to refill any of his prescriptions, and he had not taken any of his medications for almost a week. Examination In general, he appeared anxious and in mild respiratory distress. His vital signs were: temperature 36.8°C, heart rate 119 beats/min, respiratory rate 32 breaths/min, blood pressure 178/86 mmHg, and SO2 by pulse oximetry 89% on room air. His neck veins were grossly distended with elevated jugular venous pressure (JVP). Lungs demonstrated diffuse wheezes and crackles in all lung fields. Cardiac examination showed tachycardia. Abdominal and neurological examinations were normal. Lower extremities showed 3+ peripheral edema bilaterally. Laboratory Findings Hemoglobin 11.4 mg/dl Serum creatinine 1.6 mg/dl Blood urea nitrogen 35 mg/dl Sodium 139 mEq/l B-type natriuretic peptide (BNP) 1740 pg/ml Troponin <0.02 ng/ml Dietary assessment shows his breakfast is usually 2 slices of bacon and eggs or biscuits and sausage gravy. Morning snack - banana because he was told to for the potassium. Lunch: ham and cheese sandwich, handful of chips, diet pop. Afternoon snack apple or Oreo cookies. Dinner is usually a pork steak or chicken or beef steak, baked or mashed potatoes, green beans. HS snack - bowl of ice cream. What would be a good diet for this patient? Breakfast lunch and dinner?